The 2001 horror movie Session 9, set in the abandoned Danvers State Mental Hospital in Danvers, Massachusetts, tells the story of five workers who become caught up in the history of a patient who once lived there. The terrifying, murderous past becomes the equally terrifying and murderous present against the backdrop of the dilapidated structure, which operated as an asylum from 1878 to 1992. The film crew reportedly deemed the building so chilling that it merited no additional set design.

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While the film does unnerve viewers, it also offers insight into the stigma surrounding "insane asylums"—a reputation working against the preservation of these historic structures.

In the mid-19th century, the mentally ill were relegated to state prisons and poorhouses, where they were routinely abused. The activist Dorothea Dix chronicled their plight, and she and the Philadelphia-based psychiatrist Thomas Story Kirkbride lobbied for buildings where the insane could be housed and treated humanely.

Kirkbride believed in the power of the built environment to affect mental well-being. He conceived a new design for mental hospitals in which patient wings fanned out from a main central building and were staggered in such a way that each patient's room was exposed to air and light. Vast green spaces surrounded the hospitals, often with working farms where patients could tend to plants and livestock. Danvers State Hospital was built according to the Kirkbride plan.

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Kirkbride thought that the mentally ill could improve with air, light, and occupational therapy. Yet even those cases that did not, he wrote in 1854 in On the Construction, Organization and General Arrangement of Hospitals for the Insane, "should still be regarded as worthy of attention, and even if we can do no more, demanding treatment, to promote their comfort and happiness...." Around 75 Kirkbride hospitals were constructed across the country from the mid-19th through the early 20th centuries. Most were clustered in the Northeast and Midwest, but some could be found further afield, such as in Alabama, California, and Oregon.

Ultimately, Dix's and Kirkbride's visions for treatment of the mentally ill were not realized—to say the least. Though Kirkbride mandated that no more than 250 patients reside in one of his hospitals, in reality thousands did. This extreme overcrowding, along with dubious reasons for commitments and questionable treatments such as lobotomies, turned what were meant to be sanctuaries into spaces of misery—ripe for a horror movie plot.

Most Kirkbride hospitals have shuttered over the past decades. While a few are still in use as mental-health facilities, many more have been destroyed or are standing empty, under imminent threat of demolition. Danvers State Hospital was mostly razed in 2006; the shell of the central building now serves as the façade of an apartment complex.

Robert Kirkbride, the dean of the School of Constructed Environments at the Parsons School of Design (and who shares a common ancestor with Thomas Story Kirkbride), says that the stigma associated with the buildings has often hindered their conservation. "Older generations have a hard time reconciling their personal family stories, such as the uncle committed for a nebulous reason," he says, adding that most people who were committed remained in the hospital for the rest of their lives and were typically buried or cremated on site, as families did not usually retrieve the bodies.

Such a stigma makes conservation of the buildings less appealing to communities,and developers interested in the great swaths of choice land may stress the structures' melancholy past as a reason for demolition.

RobertKirkbrideis determined to counter the stigma and save his ancestor's structures. "Buildings didn't commit people. People committed people," he says. "But it's easier to blame buildings than human behavior." Kirkbride serves as spokesperson for the organization PreservationWorks, which aims to conserve the remaining asylums—but not in a rigid way.

Kirkbride says some communities assume preservation means that the hospitals will appear as if frozen in time. "That's a Disney-esque view of history that prevents our public spaces and communal identities from continuing to evolve," he says. "These buildings need to find new lives and new purposes."

PreservationWorks serves as a hub for resource-sharing among groups committed to preserving their local Kirkbride. The organization encourages new uses for the buildings, and is not preoccupied with returning them to their original style.

This doesn't mean ignoring the structures' past uses, though: Kirkbride encourages memorials or museums to explain the spaces' context. In Salem, Oregon, for instance, the Oregon State Hospital—still in use as a psychiatric facility—features a memorial completed in 2015 that houses the un-retrieved ashes of 3,500 patients. Ceramic containers holding each individual's remains comprise a low wall; families can claim the ashes, leaving new openings in the wall. "These buildings can help heal the past," Kirkbride says.

Kirkbride is also interested in finding uses for the buildings that echo the best of his ancestor's plans for them. In Traverse City, Michigan, a Kirkbride hospital now houses eldercare residences, as well as condos, eateries, and shops. Local artists receive studio space, located in patients' former rooms, in exchange for giving art lessons to elderly residents. "There's a kind of social knitting that takes place inside those spaces," says Kirkbride, adding that making art is therapeutic and ties back to his relative's stress on the importance of crafts and occupational therapy for patients.

Sometimes a hospital's new use has little to do with its original purpose. Part of St. Elizabeths in Washington, D.C., for instance, is under renovation to become offices for the Department of Homeland Security.

"These buildings served for over 100 years, and that's what they do best," Kirkbride says. "They want to serve more."

Laura's Law could provide a middle ground between the old norm of total institutionalization and the new one of total abandonment. But the statute is struggling to reconcile forestalling tragedies with patients' rights.